The Coding Compliance Auditor will conduct complex professional coding audits across all specialties to ensure accurate coding and documentation practices with all local, State and Federal rules and regulations.  This position assists all SGMF supervisors, managers and personnel with coding compliance.  This position works individually with each provider as well groups of providers.  This position is responsible to inform providers and support staff of coding updates.  This position researches coding guidelines and provides support with rejections, customer complaints and TES edits to ensure correct, compliant and consistent coding of patient charges.  This position ensures encounter forms are updated with all current CPT and ICD-9 codes. Travel is mandatory for this position. Reliable transportation is required.  The position supports the Manager, Auditing & Coding Compliance and performs ad hoc projects, as requested. 

Sutter Gould Medical Foundation (SGMF)is a non-profit, multi-specialty health care organization affiliated with Sutter Health. Based in Modesto, SGMF provides quality medical care, health education and research activities in a five-county area. SGMF's medical staff includes family practitioners, internists and pediatricians, as well as a range of specialist physicians. Services include imaging, nuclear medicine, a health library, health education programs, occupational medicine, diabetes education, nutrition counseling, infertility counseling, and weight management.

Certified Coding Compliance Auditor: High School Diploma or GED required.  Minimum 2 years healthcare experience required. AA degree in Business or Healthcare or related field preferred. Nationally recognized coding certification (CPC, CPC-P, CCS-P OR CCS) required. Successful completion of medical terminology and anatomy/physiology coursework desired. Minimum one year of coding and chart auditing  experience applying CMS documentation guidelines required.  Experience researching coding questions and deciphering government coding rules, regulations and guidelines required. Knowledge of coding and billing practices in a multi-specialty medical clinic such as would be gained with 2 years of work experience preferred. Presentation/Training experience is preferred for this position.  Experience providing one-on-one feed back to physicians preferred. Previous experience  working coding and billing denials preferred.  Previous experience updating encounter forms with CPT, ICD-9 and HCPCS codes desired.  Extensive knowledge of CPT, ICD-9 and HCPCS as well as local, State and Federal coding regulations and guidelines required.  Knowledge of instructional skills in the techniques of presentations and communication skills needed to successfully develop and conduct coding training programs.  Knowledge of and experience with computer systems for coding and abstracting required.  Knowledge of office workflow and processes.  Knowledge of problem solving techniques. Knowledge of computerized billing system required.  IDX preferred.  Knowledge of billing regulations, insurance coverage limitations and managed care protocols. Proven analytical and investigative ability. Proven ability to work with minimal supervision at a high level of productivity.  Strong organizational skills.  Excellent verbal and written communication skills in the English language.  Strong interpersonal skills.  The ability to motivate and train adults. Skills in tracking, trending, monitoring and reporting.  The ability to work independently, determine priority assignments, manage time and workflow to meet deadlines. Skills in the use of office equipment, computer and software skills are a must for this position.  Skills using Excel, PowerPoint, Microsoft Word, Outlook and creating presentations, newsletters and memos required.  Patient, financial and employee information must be protected and kept confidential.  Position requires ability to handle multiple tasks simultaneously, telephone and face-to-face contact with providers, staff and external contacts, viewing a computer monitor and reading computer-printed reports and work with frequent interruptions. Continuous attention to detail required.  Must demonstrate flexibility and be able to function under pressure. Skill in establishing and maintaining effective working relationships with providers and staff.  Skills in critical thinking and clear, understandable communication.  Ability to develop and conduct coding training.  Must be committed to providing exceptional customer service. Must maintain a high level of energy and creativity.  Must have reliable car to travel from care center for education and training.